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expert reaction to current COVID-19 situation in the UK and call from the NHS Confederation to implement Plan B

The NHS confederation has called to enact ‘Plan B plus’ to avoid ‘stumbling into winter crisis’.


Dr Julian Tang, Honorary Associate Professor/Clinical Virologist, Respiratory Sciences, University of Leicester, said:

“The rise in COVID-19 cases and related hospitalisations and deaths since August is not that surprising – if you just consider the way the host-virus relationship works, and knowing now how this virus transmits:

– with all restrictions lifted on 16 July 2021 – when the daily numbers were around 51,000, the virus would only have been able to spread further as social mixing dramatically increased, virtually overnight

– this is in addition to the waning of vaccine immunity in those vaccinated earliest (Dec-Feb), with the highly transmissible delta variant, which again acts to increase the number of COVID-19 cases

– these together with unvaccinated children returning to school in September, where full classroom mixing serves to disseminate the virus further – to their friends, classmates, teachers at school: and to their parents and siblings via their households – just adds further to the number of daily cases.

“Fluctuations in daily case numbers may be caused by many reasons – including people not coming forward to be tested, e.g. to reduce the impact of the earlier pingdemic – but this does not really impact on the overall message:

 – that the virus is still circulating, vaccination does not confer 100% protection and vaccine breakthrough infections are quite frequent with the delta variant  – see this study for example: 

– and that children are getting infected and transmitting  the virus – though they are not getting very sick in most cases.

“The rollout of booster shots and the child (12-15 yrs) vaccination programme is slow – which is understandable given the other healthcare services that now need to be catered for.

“But for those who are vulnerable they can enact their own ‘Plan B’ at any time – to look after themselves, by voluntarily wearing a mask – without having to wait for a government mandate

“This they can do to further protect themselves in crowded indoor spaces – like supermarkets – on top of any vaccine protection that they already have.

“And it doesn’t matter what other people think – they don’t know why you might be more vulnerable to severe COVID-19 – and you don’t need to explain yourself.

“Wearing a mask does not bother anyone else – and may also protect them if you are asymptomatically infected and don’t know it.”


Prof Paul Moss, of the University of Birmingham’s Institute of Immunology and Immunotherapy, said:

“It is disappointing that we are seeing higher rates of infection over the last week or two, although on the whole the death rate is relatively well-controlled.

“I am, however, concerned about the pressure on hospitals and the risk particularly to people who are immunosuppressed or immunocompromised.

“There are two factors at play here – the virus and the host. The Delta virus, which is the globally dominant variant, is very infectious and more than twice as contagious as the original Wuhan virus, while we, as the host, have changed our behaviour somewhat and we are interacting much more as a society.

“We also have to think about potential vaccine and immunity waning. It’s about one year since we had the vaccine, and it’s time to reappraise what they have achieved.  The vaccine programme has been phenomenal, and the number of deaths and hospitalisations they have prevented is remarkable.   What we are seeing now, though, is that antibody levels that developed after the second vaccine are beginning to wane and this is leading to an increase in breakthrough of infections. What is relatively reassuring is protection against very severe illness and death remains very high at 90%, so that’s encouraging. However, none of the vaccines are providing what we call ‘sterilising immunity’ and we are seeing people being re-infected with this coronavirus. That is something we will have to live with and why a third booster is vitally important.”


Dr Nathalie MacDermott, NIHR Academic Clinical Lecturer, King’s College London, said:

“The current situation of escalating numbers of daily cases in the UK is disturbing, and comments yesterday that the government are keeping a ‘close eye on daily case numbers’ are not reassuring as one would hope that they have been keeping a close eye on daily numbers throughout the pandemic. Similarly, this morning’s comments by government ministers that the UK is doing well in learning to live with the virus are not remotely reassuring, rather they suggest a dismissive attitude to the situation, which runs the risk of the UK ending up back in some form of more formal lockdown. Our European neighbours are certainly doing a better job of ‘learning to live with the virus’ than the UK is currently. Learning to live with the virus does not mean ignoring its presence, it means adopting lifestyle measures that we consistently apply to reduce the spread of the virus, but which do not impose too significant limitations on our freedoms. Wearing a facemask is an option we can all implement that will protect others, but it would seem many people no longer feel the need to do this, even in locations where it is specifically requested, such as on public transport.

“Being pre-emptive now would mean there is less likelihood of ending up in a further lockdown. Implementing Plan B now would mean less likelihood of the NHS becoming overwhelmed, which could result in soaring death rates both from COVID-19 and non-COVID related illnesses. While the vaccine booster programme and the immunisation of 12-15 year olds will assist with reducing the risk of hospitalisation and death, they are not a silver bullet that will prevent cases of the virus escalating. As immunity wanes, vaccine hesitancy slows vaccine uptake among young people and cases of other winter respiratory viruses occur as co-infections with COVID, the elderly and vulnerable are more likely to succumb to illnesses that require hospitalisation and intensive care support, even if fully vaccinated. Plan B does not result in significant limitations on our freedoms, it simply requires the wearing of facemasks in crowded areas, advising people to work from home and the introduction of COVID passports. If these three simple steps mean preventing a further lockdown (or ‘firebreak’ as the government may choose to call it) surely we can tolerate these very limited restrictions on our freedoms, and surely there is no reason for the government to hesitate in implementing it?”


Prof Lawrence Young, Professor of Molecular Oncology, University of Warwick, said:

“We are at a tipping point with increased levels of infection against a backdrop of waning vaccine-induced immunity and the easing of all restrictions. We must do everything to encourage those eligible to get their booster jabs and to vaccinate healthy 12 to 15 year olds. But we can’t rely on vaccination alone to protect us all over the winter and to prevent the NHS being overwhelmed. With the rising number of hospitalisations, Plan B measures (home orders, vaccine passports, social distancing and legally-enforced mask-wearing indoors) are looking increasingly likely. Stopping the spread of the covid-19 virus will not only protect individuals from getting sick but will also curb the generation of new virus variants that could be more infectiousness and more able to evade vaccine-induced immunity.”



Enact ‘Plan B plus’ to avoid ‘stumbling into winter crisis’



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